Monday, December 22, 2014

E-cigarette Use Among Middle and High School Students

The most recent annual survey by the National Institute on Drug Abuse (NIDA) shows that the use of regular cigarettes by middle and high school students continues to trend downward. However, for the first time the NIDA survey includes questions about the use of e-cigarettes, and the results are startling. Already, the use of e-cigarettes among middle- and high-schoolers exceeds the use of regular cigarettes. Among eighth-graders, 8.7% have used e-cigarettes but only have used regular cigarettes. And by the 12th grade, 17% have used e-cigarettes and 13.7% have used regular cigarettes.

This is the first time the annual NIDA survey has included questions about e-cigarettes, so there's no way to determine how quickly e-cigarette use is rising among young people. Within the next year or so (once we have more data) the trend will become clearer.

Health officials and e-cigarette manufacturers couldn't be farther apart on their goals for e-cigarettes. Health officials would like to see e-cigarettes used only as a useful tool to help current smokers quit smoking. Their chief concern is that e-cigarettes may encourage a whole new generation of young people to smoke who might otherwise never have smoked. E-cigarette manufacturers, on other hand, stand to reap huge profits from the much larger youth market. My guess is that the e-cigarette manufacturers are secretly pleased by the latest statistics, though I don't expect them to say so.

Although e-cigarettes are considered to be relatively safe, they do contain nicotine, an addictive drug. It will be interesting to see how (or if) the federal government or the states choose to regulate e-cigarette use in the future.

Wednesday, December 17, 2014

The FDA Approves a New Version of Gardasil

The FDA has approved a "new and improved" version of Gardasil, the controversial vaccine against Human Papillomavirus (HPV), the group of viruses that cause cervical cancer. The original Gardasil was effective against four types of HPV. The new version, called "Gardasil 9", is effective against those four types of HPV plus five more, for a total of nine.

Gardasil 9 is approved for use in both males and females. In males it is approved for prevention of anal cancer, and coincidentally it would also be effective in preventing the spread of HPV to females. Like the original Gardasil, Gardasil 9 is administered as a series of three shots.

Gardasil remains a controversial vaccine. Some people think that vaccinating young girls against a sexually transmitted virus will lead to promiscuity, even though the available suggests otherwise (see this Blog Oct. 21, 2012). There's also a rumor going around that Gardasil has caused the deaths of dozens of young women; that's not true, either, according to a leading rumor-checking site. The CDC, which collects reports of "adverse effects" on all drugs, continues to stress that Gardasil is safe.

Sunday, December 14, 2014

Does Platelet-Rich Plasma Therapy Work?

Great in theory, unproven in practice. It's been at least six years since Platelet-Rich Plasma Therapy (PRPT) was first proposed as a technique for speeding recovery from joint and connective tissue injuries, and we still don't know if it works!

In PRPT, a patient's own plasma is enriched in platelets by removal of blood cells and most of the water (see this blog Feb. 18, 2009). The remaining platelet-rich plasma is injected directly into the patient's injured joint or connective tissue. In theory, proteins and growth factors released by the platelets should speed the healing process. But do they?

The problem is that despite numerous clinical studies, the results are still inconsistent, according to an NPR article. I reported on two such studies back in 2010 (see "Platelet-Rich Plasma Therapy Revisited"). Part of the problem is that in most studies the number of patients is relatively small (fewer than a hundred patients, rather than a thousand or more) and the techniques used and types of injuries treated vary. And since it's not yet proven to work, insurance companies don't pay for the procedure, meaning that the patient pays the total cost of roughly $600 to $1,500.

We should have known by now whether the technique works. We're still waiting....

Friday, December 12, 2014

An Outbreak of Mumps in the National Hockey League

About a dozen National Hockey League players have come down with mumps in the past two months, according to CBS Sports. The outbreak seems to have started with the Anaheim Ducks (four players), but it soon spread to other teams, including the Minnesota Wild (five players), the New York Rangers (one player), and the New Jersey Devils (two players). A dozen cases of mumps on teams with a total player count of only a couple hundred players is a lot, considering that there have been only about a thousand cases of mumps in the entire country this year, according to the CDC.

But it makes sense, actually. Mumps is spread by contact with infected saliva or mucus, usually via coughing or sneezing. The close-knit conditions in a hockey locker room and frequent intense physical contact on the ice would be ideal conditions for the disease to spread. An infected person can infect others for several days before they exhibit the typical symptoms, of tiredness, fever, headaches, muscle pain, and glandular swelling - plenty of time for a hockey player to inadvertently pass his infection on to a player from another team. The Anaheim Ducks played the Minnesota Wild in mid-October. In addition, some infected persons never show the typical symptoms at all. Yet they can still infect others, making it hard to trace and eradicate an outbreak.

Although the NHL isn't too worried (mumps is not a particularly life-threatening disease), the outbreak has been disruptive in that players have had to miss games while they are sick. The league is warning teams and players about the outbreak in a hope of stemming the disease's spread. Most of the players had already been vaccinated against mumps (mumps is primarily disease of childhood, and vaccination against mumps is part of the normal vaccination regimen for children), but health officials report that the vaccine is not 100% effective; it's more like 78%. An additional vaccination can boost effectiveness to 88%, and some teams are offering the second vaccination as a precaution.